Washington state consumers would be able to do comparison pricing on medical procedures if a planned All-Payer Claims Database is successfully implemented by the state. However, it will have to be financially self-sustaining. Photo: Army Medicine.

Washington state is making progress on a planned All-Payer Claims Database (APCD) that officials now say could be ready by Fall 2017. State legislators and other stakeholders agree the state’s APCD would help consumers make better-informed decisions about which health care providers to choose for specific procedures.

Low-cost or no-cost consumer access to the database will depend on a mix of ongoing grants and especially on earned income from the likes of insurers, researchers, and perhaps large employers, paying for premium data products. Privacy safeguards will be a priority. Currently, 12 states have APCDs and six more including Washington are currently planning to implement them.

Flying Blind On Price

The lack of consumer health care cost data is increasingly an anomaly. If you’re online buying a tablet, a blouse, a crockpot or a Halloween costume, you can comparison shop down to the last penny, and read dozens of user reviews.

But if you’re in the market for anything from knee surgery to a doctor’s assessment of a potential sinus infection, or dozens of other medical services, you’re likely flying blind on out-of-pocket costs, which can vary widely by provider and insurer.

As health care gets more and more expensive, employers and consumers are looking for ways to control costs without sacrificing quality. Although enabling legislation on Washington’s APCD was approved in 2014 and expanded in scope in 2015, contractor team assembly proved challenging. Now, that hurdle has been cleared.

Price Transparency To Boost Competition

“We’re hoping that the increased transparency will actually help stimulate competition so that people can actually compare prices and know who is actually providing quality health care efficiently,” State Rep. Eileen Cody (D-34) told Lens. She is Chair of the House Health Care and Wellness Committee.

“Employers will have the ability to take a look at costs their employees would be facing when they have to go to a doctor visit or for a medical procedure,” State Sen. Randi Becker (R-2) told Lens. This can help employers choose a plan, and covered employees or other covered individuals pick a provider, she added. Becker is Chair of the Senate Health Care Committee.

Currently at Washington’s Healthplanfinder, consumers without employer coverage can comparison shop for insurers, but cannot review pricing of procedures at different hospitals or clinics.

“A person can’t go in and say ‘if I had a colonoscopy how much would it cost me here or cost me there,’” Becker said.

Savings For Employers And Consumers

Cody told Lens utilizing the database will result in savings for both employers and consumers. “Let’s say a doctor orders a MRI for you, you’d be able to look for how much co-pays are these days.” Employers could then “figure out where is the cheapest place to go and get the best deal for [their employees],” said Cody.

Dr. Roger Stark, Health Care Policy Analyst for the Washington Policy Center, compared using the database to walking into a grocery or clothing store.

“You want to know pricing or quality…same thing with medicine,” Stark told Lens. “Patients have not been consumers of health care and are not savvy shoppers. This is another mechanism to get them a tool to shop around; not only on quality [but also] pricing.”

Insurers See Benefits, As Well

Insurers are also welcoming the approach. “At Premera, we believe that greater understanding of the cost of care will help better manage our own healthcare,” said Melanie Coon, senior communications manager, public affairs. Coon added the APCD “is part of a longer-term effort by all of us to increase quality while managing costs.”

The 2014 legislation and Becker’s subsequent Senate bill approved into law in 2015 together set the framework for determining how to obtain and release APCD data, run the database and price its products.

Washington State’s Office of Financial Management (OFM) is heading implementation, but had trouble finding a contractor to manage the database. OFM also missed a deadline earlier this year to finalize APCD data privacy rules that adhere to state and federal law. That remains a key task, on which further work will start in January.

OFM on July 27 announced that the Center for Health Systems Effectiveness (CHSE) at Oregon Health and Science University (OHSU) would run Washington’s APCD. Subcontractors include Maine-based data collector Onpoint Health Data and Forum One, a communications and digital agency with a Seattle office.

Public-Facing Website Will be Key

According to a CHSE press release this month, the center’s role “will include recruiting Washington stakeholders for two data-governance committees, overseeing data collection by Onpoint, and working with Forum One to design a website to communicate the project to the public.”

Thea Mounts, APCD program director said, “The expectation is the first round of data will be in the system and available for release in the fall of 2017.”

Under an OFM timeline, the next phase of rulemaking will begin in January, tied to compliance with state and federal privacy laws.

Cody said the approved 2014 APCD bill she sponsored included provisions to help prevent possible data breaches. In the bidder selection process, higher ratings were given to organizations with prior experience in data security systems. Once the database is up and running, the vendor is required to demonstrate “state of the art encryption methods” for collecting and transferring data.

The APCD rulemaking process will include formulation of measures to prevent “inappropriate disclosures or uses” of direct and indirect patient identifiers, and of proprietary financial data.

Must Pay For Itself

State law requires the database to be financially sustainable once up and running. The lead organization must develop a plan to charge fees for “reports and data as needed to fund the database.” Solvency will likely depend on data purchasers’ interest in the data and whether federal and foundation grants are available, according to Mounts.

“There is the expectation there will be several products available for free to the public” but at the same time, more detailed data requests from parties such as insurers or academic institutions could require that fees be paid, Mounts indicated.

Mike Richards grew up in Charlotte, North Carolina. He graduated from Duquesne University in Pittsburgh, PA with a degree in Multiplatform Journalism and a minor in Public Relations. He wrote and published articles at Pittsburgh’s NPR station covering a variety of topics.